Your Guide to Contraception with Your Minimum
Essential Coverage Benefits
Having your provider submit your claim to KBA with the correct coding is the first key to receiving
accurate payment for these services. Ask your provider how your visit will be billed prior to your visit
to avoid misunderstandings and feel at ease.
Some key points to bring up are:
• Let your provider know that preventive care services must be submitted with an ICD-9 code
that describes encounters with health services that are not for an illness or treatment of injury.
• These diagnosis codes must be the primary code on the claim form.
• If you or your provider have any questions please tell them to reach out to 877.851.0906 for
more information about the services covered under MEC.
• The second key is making sure these services occur at a MultiPlan provider. Please ask your HR
Manager for our MultiPlan Provider Lookup Guide. Remember out of network MEC services will
only be covered at 40%, even if correct coding is present.
You’ll be glad to hear that all female
contraception, whether it be a prescription
or procedure, will be covered at 100%
(in-network) under your MEC benefits.
If you are in childbearing age range, talk to
your OBGYN about what contraception is
right for you. Please also note that your
plan only covers female contraceptives
and female sterilization procedures that are
FDA approved.
Female condoms
You can purchase female condoms at most
pharmacies. You will want to pay out of
pocket for these. When you submit your
paper claim for reimbursement, please
include a receipt, as well as some way to
identify your purchase.
www.kbasolution.com :: P.O. Box 129 :: Fort Mill, SC 29715 :: 877.851.0906
Diaphragms
Traditional latex diaphragms must be the correct size to work properly, and a health care provider
can determine the proper fit and give you a prescription. You will pay out of pocket and when you
submit your paper claim for reimbursement, please include a full receipt with a description of the
device. Spermicidal cream or jelly should be used with a diaphragm and can be purchased at the
pharmacy. A diaphragm should be replaced after 1 or 2 years. Newer diaphragms, such as the Silcs
diaphragm, are currently in clinical trials for approval by the U.S. Food and Drug Administration
(FDA), but have not been approved yet, therefore will not be covered under the plan.
Spermicides
A spermicide destroys sperm. A spermicide can be used alone or in combination with a diaphragm
or cervical cap. It is available in several concentrations and forms, including foam, jelly, cream,
suppository, and film. You will pay out of pocket and when you submit your paper claim for
reimbursement, please include a full receipt with a description of the product.
A diaphragm should be replaced after 1 or 2 years. With proper
care, a cervical cap can be used for 2 years before replacement.
Contraceptive sponges
These are soft, disposable, spermicide-filled foam sponges. Currently, the Today® Vaginal Contraceptive
Sponge is the only sponge approved by the FDA. You will pay out of pocket and when you submit your
paper claim for reimbursement, please include a full receipt with a description of the product.
Cervical caps
These are similar to diaphragms, but smaller, more rigid, and less noticeable. Cervical caps come in
different sizes, and a health care provider determines the proper fit. You will pay out of pocket and
when you submit your paper claim for reimbursement, please include a full receipt with a description of
the devise. With proper care, a cervical cap can be used for 2 years before replacement. Currently,
FemCap is the only cervical cap approved by the FDA.
www.kbasolution.com :: P.O. Box 129 :: Fort Mill, SC 29715 :: 877.851.0906
Hormonal Methods:
Oral contraceptives
These are commonly referred to as the pill. There are many different formulations of oral
contraceptives are available, and a health care provider helps to determine which type best fits your
needs. You will receive a prescription for these pills, and you will pay out of pocket and submit a paper
claim with full receipt for reimbursement.
Combined oral contraceptive pills (COCs) contain different combinations of the synthetic estrogens and
progestins. One pill is taken daily, preferably at the same time each day. Use of COC pills is not
recommended for women who smoke tobacco and are more than 35 years old or for any woman who
has high blood pressure, a history of blood clots, or a history of breast, liver, or endometrial cancer.
Progestin-only pills (POPs). POPs alter the normal cyclical changes in the uterine lining and may result in
unscheduled or breakthrough bleeding, but these hormones do not appear to be associated with an
increased risk of blood clots.
Emergency Contraceptive Pills (ECPs)
ECPs are hormonal pills, taken either as a single dose or two
doses 12 hours apart, which are intended for use in the
event of unprotected intercourse. Pregnancy can occur if
the pills are taken after ovulation or if there is subsequent
semen exposure in the same cycle. Most pharmacies will
carry these pills on the shelf, so you do not need to have a
prescription. You will need to pay out of pocket and submit
a paper claim with full receipt for reimbursement. Please
talk to your pharmacist about proper use before taking.
Contraceptive patch
This is a thin, plastic patch that sticks to the skin and
releases hormones through the skin into the bloodstream.
Currently, Ortho Evra® is the only patch that is FDA
approved. You will receive a prescription for the patch, and
you will pay out of pocket and submit a paper claim with
full receipt for reimbursement.
www.kbasolution.com :: P.O. Box 129 :: Fort Mill, SC 29715 :: 877.851.0906
Vaginal rings
The ring is thin, flexible, and approximately 2 inches in diameter. It delivers a combination of a
synthetic estrogen (ethinyl estradiol) and a progestin. The ring is inserted into the vagina, where it
continually releases hormones for 3 weeks. The woman removes it for the fourth week and reinserts a
new ring 7 days later. Risks for this method of contraception are similar to those for the combined
oral contraceptive pills, and a vaginal ring is not recommended for any woman with a history of blot
clots, stroke, or heart attack, or with certain types of cancer. You will receive a prescription for the
ring, and you will pay out of pocket and submit a paper claim with full receipt for reimbursement.
Currently, the NuvaRing® is the only FDA-approved vaginal ring.
Injectable birth control
This method involves injection of a
progestin, Depo-Provera® (DMPA—depo
medroxyprogesterone acetate), given in the
arm or buttocks once every 3 months.
These injections will be administered at
your physician’s office and your healthcare
provider should submit the claim for you,
so you do not have to pay out of pocket.
Implantable rods
Each rod is matchstick-sized, flexible, and
plastic. A physician surgically inserts the rod
under the skin of the woman's upper arm.
The rods release a progestin and can remain
implanted for up to 5 years. Currently,
Implanon®, which releases etonorgestrel,
is the only implantable rod available in the
United States. This procedure will be
administered at your physician’s office and
your healthcare provider should submit the
claim for you, so you do not have to pay
out of pocket.
www.kbasolution.com :: P.O. Box 129 :: Fort Mill, SC 29715 :: 877.851.0906
Intrauterine Methods:
Sterilization:
An IUD is a small, T-shaped device that is inserted into
the uterus to prevent pregnancy. A health care
provider inserts the device. An IUD can remain and
function effectively for many years at a time. After the
recommended length of time, or when the woman no
longer needs or desires contraception, a health care
provider removes or replaces the device. Because the
device and procedure is available at the healthcare
provider, you will not have to pay out of pocket if your
physician’s office is able to submit the claim.
Sterilization is a permanent form of birth
control that either prevents a woman from
getting pregnant or prevents a man from
releasing sperm. A health care provider
must perform the sterilization procedure,
which usually involves surgery.
These procedures usually are not
reversible. Your MEC benefits would
only cover female sterilization.
A copper IUD releases a small amount of copper into
the uterus, causing an inflammatory reaction that
generally prevents sperm from reaching and fertilizing
the egg. If fertilization of the egg does occur, the
physical presence of the device prevents the fertilized
egg from implanting into the lining of the uterus.
Copper IUDs may remain in the body for 12 years.
A copper IUD is not recommended for women who
may be pregnant, have pelvic infections, or had uterine
perforations during previous IUD insertions. It also is
not recommended for women who have cervical
cancer or cancer of the uterus, unexplained vaginal
bleeding, or pelvic tuberculosis. Currently, ParaGard®
is the only FDA-approved copper IUD.
A hormonal IUD releases a progestin hormone into the
uterus. The released hormone causes thickening of the
cervical mucus, inhibits sperm from reaching or
fertilizing the egg, thins the uterine lining, and
also may prevent the ovaries from releasing eggs.
Hormonal IUDs can be used for up to 5 years.
Currently, Mirena®, a levonorgestrel-releasing IUD, is
the only FDA approved hormonal IUD that is available.
A sterilization implant is a nonsurgical
method for permanently blocking the
fallopian tubes. A health care provider
threads a thin tube through the vagina and
into the uterus to place a soft, flexible
insert into each fallopian tube. No incisions
are necessary. During the next 3 months,
scar tissue forms around the inserts and
blocks the fallopian tubes so that sperm
cannot reach an egg. After 3 months, a
health care provider conducts tests to
ensure that scar tissue has fully blocked the
fallopian tubes. A backup method of
contraception is used until the tests show
that the tubes are fully blocked.
Tubal ligation is a surgical procedure in
which a doctor cuts, ties, or seals the
fallopian tubes. This procedure blocks the
path between the ovaries and the uterus.
The sperm cannot reach the egg to fertilize
it, and the egg cannot reach the uterus.
www.kbasolution.com :: P.O. Box 129 :: Fort Mill, SC 29715 :: 877.851.0906